BACKGROUND: Left ventricular dyssynchrony is an adverse consequence of ST-elevation myocardial infarction (STEMI) and bears an unfavorable prognosis. Mechanical dyssynchrony as measured by phase analysis from gated single photon emission computed tomography (GSPECT) correlates well with other imaging methods of assessing dyssynchrony but has not been studied in STEMI. We hypothesized that systolic dyssynchrony as measured by GSPECT would correlate with adverse remodeling after STEMI. METHODS: In 28 subjects suffering STEMI, GSPECT with technetium-99m sestamibi was performed immediately after presentation (day 5) and remotely (6 months). Parameters of left ventricular dyssynchrony (QRS width, histogram bandwidth (HBW) and phase standard deviation (PSD)) were measured from GSPECT using the Emory Cardiac Toolbox. Left ventricular volumes, ejection fraction (LVEF) and infarct size were also assessed. RESULTS: After successful primary percutaneous coronary intervention to the infarct-related artery, subjects had an LVEF of 46.4% ± 11% and a resting perfusion defect of 27.4% ± 16% at baseline. Baseline QRS width was normal (91.5 ± 17.5 ms). Subjects with STEMI had dyssynchrony compared with a cohort of 22 normal subjects (age 57.2 ± 10.6 years, <5% perfusion defect) by both HBW (100.3° ± 70.7° vs 26.5° ± 5.3°, P < .0001) and PSD (35.3° ± 16.9° vs 7.9° ± 2.1°, P < .0001). Baseline HBW correlated with resting perfusion defect size (r = 0.67, P < .001), end-systolic volume (r = 0.72, P < .001), end-diastolic volume (r = 0.63, P = .001), and inversely with LVEF (r = -0.74, P < .001). HBW and PSD improved over the follow-up period (-24.1 ± 35.9 degrees, P = .003 and -8.7° ± 14.6°, P = .006, respectively), and improvement in HBW correlated with reduction in LV end-systolic volumes (r = 0.43, P = .034). Baseline HBW and PSD, however, did not independently predict LVEF at 6 months follow-up. CONCLUSIONS: After STEMI, subjects exhibit mechanical dyssynchrony as measured by GSPECT phase analysis without evidence of electrical dyssynchrony. Improvement in mechanical dyssynchrony correlates with beneficial ventricular remodeling. The full predictive value of this measure in post-infarct patients warrants further study.
BACKGROUND:Left ventricular dyssynchrony is an adverse consequence of ST-elevation myocardial infarction (STEMI) and bears an unfavorable prognosis. Mechanical dyssynchrony as measured by phase analysis from gated single photon emission computed tomography (GSPECT) correlates well with other imaging methods of assessing dyssynchrony but has not been studied in STEMI. We hypothesized that systolic dyssynchrony as measured by GSPECT would correlate with adverse remodeling after STEMI. METHODS: In 28 subjects suffering STEMI, GSPECT with technetium-99m sestamibi was performed immediately after presentation (day 5) and remotely (6 months). Parameters of left ventricular dyssynchrony (QRS width, histogram bandwidth (HBW) and phase standard deviation (PSD)) were measured from GSPECT using the Emory Cardiac Toolbox. Left ventricular volumes, ejection fraction (LVEF) and infarct size were also assessed. RESULTS: After successful primary percutaneous coronary intervention to the infarct-related artery, subjects had an LVEF of 46.4% ± 11% and a resting perfusion defect of 27.4% ± 16% at baseline. Baseline QRS width was normal (91.5 ± 17.5 ms). Subjects with STEMI had dyssynchrony compared with a cohort of 22 normal subjects (age 57.2 ± 10.6 years, <5% perfusion defect) by both HBW (100.3° ± 70.7° vs 26.5° ± 5.3°, P < .0001) and PSD (35.3° ± 16.9° vs 7.9° ± 2.1°, P < .0001). Baseline HBW correlated with resting perfusion defect size (r = 0.67, P < .001), end-systolic volume (r = 0.72, P < .001), end-diastolic volume (r = 0.63, P = .001), and inversely with LVEF (r = -0.74, P < .001). HBW and PSD improved over the follow-up period (-24.1 ± 35.9 degrees, P = .003 and -8.7° ± 14.6°, P = .006, respectively), and improvement in HBW correlated with reduction in LV end-systolic volumes (r = 0.43, P = .034). Baseline HBW and PSD, however, did not independently predict LVEF at 6 months follow-up. CONCLUSIONS: After STEMI, subjects exhibit mechanical dyssynchrony as measured by GSPECT phase analysis without evidence of electrical dyssynchrony. Improvement in mechanical dyssynchrony correlates with beneficial ventricular remodeling. The full predictive value of this measure in post-infarctpatients warrants further study.
Authors: Maureen M Henneman; Ji Chen; Petra Dibbets-Schneider; Marcel P Stokkel; Gabe B Bleeker; Claudia Ypenburg; Ernst E van der Wall; Martin J Schalij; Ernest V Garcia; Jeroen J Bax Journal: J Nucl Med Date: 2007-06-15 Impact factor: 10.057
Authors: Ji Chen; Maureen M Henneman; Mark A Trimble; Jeroen J Bax; Salvador Borges-Neto; Ami E Iskandrian; Kenneth J Nichols; Ernest V Garcia Journal: J Nucl Cardiol Date: 2008 Jan-Feb Impact factor: 5.952
Authors: Ji Chen; Ernest V Garcia; Russell D Folks; C David Cooke; Tracy L Faber; E Lindsey Tauxe; Ami E Iskandrian Journal: J Nucl Cardiol Date: 2005 Nov-Dec Impact factor: 5.952
Authors: Jonathan P Piccini; Aijing Z Starr; John R Horton; Linda K Shaw; Kerry L Lee; Sana M Al-Khatib; Ami E Iskandrian; Christopher M O'Connor; Salvador Borges-Neto Journal: J Am Coll Cardiol Date: 2010-07-13 Impact factor: 24.094
Authors: Arshed A Quyyumi; Edmund K Waller; Jonathan Murrow; Fabio Esteves; James Galt; John Oshinski; Stamatios Lerakis; Salman Sher; Douglas Vaughan; Emerson Perin; James Willerson; Dean Kereiakes; Bernard J Gersh; Douglas Gregory; Astrid Werner; Thomas Moss; Wai Shun Chan; Robert Preti; Andrew L Pecora Journal: Am Heart J Date: 2011-01 Impact factor: 4.749
Authors: Mark A Trimble; Salvador Borges-Neto; Stuart Smallheiser; Ji Chen; Emily F Honeycutt; Linda K Shaw; Jaekyeong Heo; Robert A Pagnanelli; E Lindsey Tauxe; Ernest V Garcia; Fabio Esteves; Frank Seghatol-Eslami; G Neal Kay; Ami E Iskandrian Journal: J Nucl Cardiol Date: 2007-04-18 Impact factor: 5.952
Authors: Maureen M Henneman; Ji Chen; Claudia Ypenburg; Petra Dibbets; Gabe B Bleeker; Eric Boersma; Marcel P Stokkel; Ernst E van der Wall; Ernest V Garcia; Jeroen J Bax Journal: J Am Coll Cardiol Date: 2007-04-05 Impact factor: 24.094
Authors: Sjoerd A Mollema; Su San Liem; Matthew S Suffoletto; Gabe B Bleeker; Bas L van der Hoeven; Nico R van de Veire; Eric Boersma; Eduard R Holman; Ernst E van der Wall; Martin J Schalij; John Gorcsan; Jeroen J Bax Journal: J Am Coll Cardiol Date: 2007-10-01 Impact factor: 24.094
Authors: Luis Eduardo Juarez-Orozco; Andrea G Monroy-Gonzalez; Friso M van der Zant; Nick Hoogvorst; Riemer H J A Slart; Remco J J Knol Journal: J Nucl Cardiol Date: 2018-11-15 Impact factor: 5.952